Pioneer Work with Cerebral
By EIRENE COLLIS
Chief Cerebral Palsy Therapist to the London County Council
A quarter of a century ago pioneer work in
Cerebral palsy was begun in America by Dr.
Winthrop Morgan Phelps. He realized what
~r- Little had had an inkling of in 1830?that
'he child with cerebral palsy is not necessarily
Mentally affected by the damage to his brain;
the right hands his condition can be considerably
Meliorated.
In 1941 the present writer returned from America,
having studied Dr. Phelps' work at his private
school, near Baltimore, from the angle of the thera-
pist. it Was not possible to arouse any interest,
In that
year of war, in children with a long recognized
c?ndition of cerebral damage. Many people were
sympathetic, but no more.
In 1942 the then Medical Superintendent of
VUeen Mary's Hospital for Children, Carshalton,
decided to give experimental facilities for cerebral
Palsy work along Dr. Phelps' lines of treatment.
u% a few children could be taken and they were
jjnselected cases. Work had to be done in a
hospital ward and under the very difficult conditions
01
wartime. Staff was unobtainable for special
care of these
children, and, previously, the habit
the hospital had been to regard them as mentally
^ elective chronics. After more than a year of
ard work, results, even under wartime difficulties
a vvart*
routine, were far in excess of those of
ther methods, and interest was aroused, resulting
J1 the formation of the Cerebral Palsy Unit, the
Fst of its kind in the country. The children were
block to themselves. A teacher was
fyen a
ejected to become conversant with their special
?nc* to work with them in school. Assistant
tj?e<^s
, erapists were appointed. Ward routine was
one away with and a normal child's
day was
r8anized. Unfortunately, the long waiting list
?uld only slowly be reduced, and a selective
cthod of admittance had to be introduced in
rder to cope with increasing demands. To have
0
Work slowly was disheartening, but a good deal
pKm
keen done to lead the way to better things for
h^dren with this disability.
tarly on it was suggested to some of the parents
at
they should form themselves into a club and
0rk for the
good of all cerebral palsies. This
m
Palsy
was done and a large Association has grown out
of that small Parents' Club.
The staff of the Unit had often to break off
work to give details and information to parents,
doctors, teachers, educationists, physiotherapists,
occupational therapists and speech therapists who
wanted to gain information about the new work.
Some of these decided to set up on their own and
others decided to practise some of the methods
in their own hospitals. Such things as walking
"
skis" were much admired and made use of
as adjuncts.
The children in the unit and
multiplied gradually
hospital difficulties were overcome by increasing
freedom. The staff and children learned to work
together happily ; but there were not enough of
the former and too many of the latter waiting for
help. It is only possible to treat a certain number
of children with a certain number of staff ; cerebral
palsies who are helpless require a good deal of
looking after outside treatment times. During
the war it was not always possible to have ideal
conditions in a new departure of this kind. Now
that so much interest has been aroused and so
many people, official bodies and unofficial individ-
uals, have seen and accepted and are starting work
on children with cerebral palsy, staff will rapidly
become available and more children taken in and
more parents made happy in the knowledge that
everything possible is being done to ameliorate
their child's condition.
The Unit is in the closest possible touch with the
great pioneer in this work, Dr. Phelps, and an
effort is made to adhere as closely as ever to his
teaching and to carry on his therapy.
The work has now passed beyond the experi-
mental stage. There is no doubt whatever of the
improvement in the children's motor behaviour,
and psychologically they are different beings.
From helpless invalids tied down in bed and treated
as sick and of poor mentality, they have become
children with a full and happy life, engaged upon
overcoming a disability while filling in a normal
day with school, outdoor play, indoor amusements,
meals in a special dining room, where they can win
"
"
promotion to the big table by learning the art
36 MENTAL HEALTH
of self-feeding at individual tables specially equipped
to help them to help themselves; and at night
they sleep in their own dormitory, boys on one
side, girls on the other.
The health and physique of these children rapidly
improved and they put on weight after removal
from a hospital ward to a special unit. They are
always hungry for their meals and ready to join
in all activities. One keeps rabbits, another
collects toy motor cars, another is a balletomane,
practising arm movements whenever she has a
spare moment. A rhythm band was started and
the first concert was given over a year ago. The
parents were invited and many of them could not
believe what they saw and heard their children do.
Eurythmy is also taught and the children love it.
They had a nice garden before they left the ward
conditions, and now they are hoping to cultivate
a larger bit of ground. ? is consistently found that there is no true psycho-
Treatment routine is very strict, though it is not
as frequent as it will be when more staff can take
it over. The children have physiotherapy, occupa-
tional therapy, activities, speech therapy and
school. On admission to the unit each child is
examined and his type and degree of disability
assessed. A treatment scheme is devised and
routine work begun. Studies of the child are made
at frequent intervals, graphs being made to demon-
strate the rate of progress in the different aspects
of work. It is recognized that the child must
inevitably do his own work ; he is guided and taught
by the therapy staff, but control of his body cannot
be achieved for him. This, and the development
of his mind, are what he learns during his life in
the unit. Service to the child with cerebral palsy
is the aim of the unit and each child contributes to
the service of the others. By this means he becomes
independent and loses the sense of frustration so
common in the child with this kind of disability.
Cerebral palsy is a general term to designate
motor and sensory disturbances which result from
brain damage ; it is not a diagnosis of the particular
condition of each particular child. The therapist
must know the total handicap in each case, and to
obtain a picture of this the five classifications made
by Phelps are strictly adhered to. These are made
on a motor basis and are determined by detailed
neurological and functional examinations, carefully
interpreted in each case. A certain amount of
research has been possible and it has been found
that movement, both of normal persons and of
cerebral palsied persons, tends to be distinguishable
into differently controlled broad types, and such
movement is affected by the various cerebral condi*
tions of these children and can only be trained satis-
factorily by persons who are students of muscle and
movement. Dr. Phelps has laid down basic
principles of training for these children, and the
therapy findings of the present writer completely
bear out his divisions and classifications according to
which treatment is differentiated. Sensory dis-
abilities have been similarly worked upon and with
concurrent findings. The psychological differentia-
tions worked out by Phelps are allied to the types
of difficulty experienced by each individual, and it
logical problem with the cerebral palsy child per se,
and that behaviour abnormalities clear up so soon
as the disability is handled with understanding-
New findingsare to be published elsewhere in due
course and it is hoped that they will prove helpfu'
to all who enter the cerebral palsy field.
For best results therapy should be begun early
in and intensive training for the child and
life,
concurrent training for the parent carried out
until a satisfactory routine has been established.
In the first cerebral palsy unit in this country>
there have been very happy relations with all parents
whose children have been in training and it is the
confidence and tact they have shown that has
smoothed some difficult passages in this pioneer
work. To them and to their children we are
indebted for showing us the way to a correct
routine. Their loyal co-operation has helped
their children as nothing else could have done
during the difficult first years of establishing some-
thing new and different in an old and long standing
hospital regime. The cerebral palsy unit is stilla
housed in the grounds of the hospital, but in
separate building, with its own playground, garden
and schoolrooms. It is hoped to make it a model
unit and to give every chance to as many children
as possible now that the war is over and the spade
work done.